PRIMEVIEW

HEPATITIS C VIRUS INFECTION

For the Primer, visit doi:10.1038/nrdp.2017.6

Hepatitis C virus (HCV) is a DIAGNOSIS

MANAGEMENT
hepatotropic RNA virus. Following
acute infection, the majority of patients
HCV infection is often asymptomatic, until
develop chronic liver inflammation that
the liver damage has progressed. Diagnostic,
can result in cirrhosis and hepatocellular
screening and monitoring procedures include
carcinoma. HCV infection is the leading
HCV antibody testing, HCV RNA measurement,
indication for liver transplantation in many
viral genotype and subtype determination
parts of the world.
and the assessment of resistance-associated
substitutions, which are genetic substitutions
Between 2013 that make the virus less susceptible
EPIDEMIOLOGY Interferon (IFN)‑based and 2016,
to commonly used DAAs.
treatment used to be 11 different
direct-acting
45–85%
The global prevalence of HCV infection, based common practice, of infected
but cure rates were RNA replication antiviral
on the detection of viral RNA in the blood, has agents individuals are PREVENTION
been estimated at ~1%, which corresponds to suboptimal and adverse unaware of their
effects were common. (DAAs)
~80 million infections. The age distribution of against three condition.
In some parts of the
infection varies across countries. The average age viral proteins HCV is mainly transmitted
world, including Asia,
of infected individuals is considerably lower in NS5B (NS3/4A, NS5A through percutaneous exposure
these regimens are still RNA NS5A
countries where injection drug use is an ongoing replication and NS5B) have to infected blood owing to unsafe
being used. complex Polymerase been approved.
risk factor (~35 years) than in countries inhibitors
injection drug use or medical procedures.
inhibitors
where iatrogenic infections (that Causes of iatrogenic infections range from
50–60%
is, infections due to a medical of HCV blood transfusions or administration of clotting
procedure) are the main cause DAAs have revolutionized factors (prior to screening that started in the
infections in
(~50–60 years). In addition, HCV the treatment of HCV infection. 1990s) to reuse of contaminated materials.
Europe and the
genotypes — seven of which A combination of two or three Prevention is aimed at minimizing the risk of
United States are due
have been detected thus far Polyprotein translation DAAs can cure (defined as a transmission: avoid direct exposure to blood;
to unsafe injection and processing
— show geographical variation. sustained virological response do not share needles or personal care items;
drug use.
NS3/4A or the absence of viral RNA only use licensed tattoo and piercing parlours;
12 weeks after treatment) and avoid risky sexual activities. Screening of
NS3/4A protease inhibitors >90% of patients. individuals at increased risk is recommended.

Development and
1986 IFN treatment era 2011 approval of DAAs 2017
<0.75%
0.75–2.9% HCV infection can be associated
>2.9% MECHANISMS with extrahepatic manifestations.

Worldwide prevalence varies considerably, The balance between HCV interplay between the innate important driver of fibrogenesis,
with the highest prevalence in countries with clearance (the resolution and adaptive immune systems, characterized by the activation HC V
past or present history of iatrogenic infections. of acute infection) and but the precise mechanisms of hepatic stellate cells into
Some African and Asian countries have a persistent infection (chronic remain incompletely understood. myofibroblasts, which produce
prevalence of >5% in the adult population. HCV infection) depends on an Local liver inflammation is an excess extracellular matrix.

Written by Liesbet Lieben; designed by Laura Marshall Article number: 17007; doi:10.1038/nrdp.2017.7; published online 2 Mar 2017
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